This doctoral dissertation examines strategies to reduce and eliminate the use of coercion in mental health care within the context of deinstitutionalisation. It is grounded in international human rights standards, particularly the United Nations Convention on the Rights of Persons with Disabilities. The research was conducted as part of a project to transform the Dom na Krasu residential social care institution between 2020 and 2023, using an action research approach. The study aimed to understand the realities of the research setting in relation to the theoretical framework; to reduce or eliminate coercive practices in the secure (closed) unit and other units of the institution; and to integrate theoretical and practical insights into a coherent deinstitutionalisation programme for secure units. Data were collected through action (including direct work with residents), conversation, observation, and documenting. The findings indicate that the organisational arrangements of the secure unit (particularly the locked doors and generalised security measures) restrict residents’ living environments and increase their dependence on staff. As a result, the secure unit fails to fulfil its legally defined role and represents an inappropriate form of care. The action research group demonstrated that certain methods have the potential for non-coercive work. Admission procedures to the secure unit function as degradation ceremonies, labelling users as dangerous to justify their access to “intensive” care. Discharges were rare, largely due to fragmented and insufficient community-based services. Within community services and the institution itself, the secure unit serves as a site of exclusion for those deemed dangerous. Efforts to reduce coercion through organisational change were unsuccessful. Secure units should be abolished and replaced by diverse, interconnected community-based forms of support. Consistent and proactive policy and legislation are essential to eliminate coercion.
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